Healing the System

Almost everyone agrees that our healthcare system needs reform. The question is, where do we begin? Some local leaders believe they have the answers.

Robert Perkins, vice president of AstraZeneca, says the failing economy, coupled with the federal healthcare reform debate, has “blurred our focus on state solutions for now.” Photograph by Carlos AlejandroAstraZeneca vice president Robert Perkins says some surveys indicate that nearly 90 percent of Americans are satisfied with their healthcare coverage. Blue Cross/Blue Shield of Delaware CEO Tim Constantine says availability of specialized treatments and procedures, funding for medical education and research, and lack of long waits for care make the United States’ healthcare system superior to any European or Canadian single-payer model. So what’s the fuss over reform all about?

“There are 46 million or 47 million people in this country currently uninsured, the cost of care is too high, and the outcomes of the care that is provided are not where they should be,” says Constantine.

In other words there, are serious cracks in our system that, according to some providers and government administrators, threaten to bring down the house. Some local industry and government leaders believe they know where reform should start.

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In 2007 a consortium of Delaware healthcare stakeholders sought to determine what action could be taken to make healthcare better for Delawareans. The focus of that summit immediately became the state’s 100,000 uninsured.

“We thought the summit might raise the level of debate on the state of the uninsured, as well as generate a consensus on what the state’s employers and charities could achieve in getting the uninsured covered,” says Perkins.

Though participants believed the issue could be addressed with some success, the over-arching problem of the uninsured nationwide may be the key to meaningful and sustainable reform.

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Paula Roy is executive director of the Delaware Healthcare Commission, which was founded in 1990 to promote accessible, affordable healthcare for all Delawareans. Roy says it made “sense to look at the uninsured and determine strategies that were both targeted to specific groups and were doable.

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“There have been many strategies with mixed results over the years,” she says. “Affordability is a big issue, especially for small business, and then there’s that group between the ages of 18 and 29 that we call the ‘young invincibles’ because they don’t feel the need to purchase health insurance, even though they can afford it.”

One reform initiative was to increase enrollment of those eligible for primary public health programs. It was agreed that building bridges between public health programs and programs for lower-income families would make more people aware that they may qualify for public insurance. But in a downturned economy, the dialogue has stalled. “Plus now we have the federal healthcare reform debate, and that has further blurred our focus on state solutions for now,” Perkins says.

Rita Landgraf was AARP’s state president at the time of the summit. Now she is secretary of the Department of Health and Human Services. “The summit led to a framework that would be collaborative among the various agencies providing services for the disadvantaged,” she says, “to cross-reference clients receiving services such as school lunches who would qualify for state-supported health insurance as well.”

John Taylor, executive director of the Delaware Public Policy Institute, which hosted the meeting, says one accomplishment was uniting individuals who did not normally convene to address common issues.

“The idea of stovepiping the artificial barriers that can grow among disparate groups seeking to solve mutual problems is very real in the area of healthcare,” Taylor says. “The advantage of a DPPI event is that we are neither public nor private, and so we can bring in a broad group and get them around the table all talking about the next big steps to take.”

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Another resulting initiative was to increase efforts to enroll those who are eligible for primary public health programs such as Medicaid and Delaware Healthy Children Program (DHCP). It was agreed that building bridges between public health programs and programs for lower-income families would make more people aware that they may qualify for public insurance.

The summit report notes, for example, that “since children in the federally sponsored nutrition programs are nearly always eligible for Medicaid or DHCP, these programs could inform parents of their eligibility for health coverage.”

All well and good, but as Roy understood, “To have all eligible low-income families suddenly covered would require a big public subsidy,” not to mention expensive new administration.

Then came the economic meltdown and state budget crises, which have brought all summit initiatives to a grinding, if temporary, halt. “With the economy worsening, we knew we could not continue the dialogue that we had hoped to,” Perkins says. “Plus now we have the federal healthcare reform debate, and that has further blurred our focus on state solutions for now.”

Ultimately, according to Blue Cross/Blue Shield’s Constantine, the rising costs of healthcare must be contained. He identifies four areas that continue to drive costs. “First is simply the cost of new technologies and medications,” he says. “This is a positive, but at the same time, we have an aging population accessing more and more of this expensive care.”

Constantine points to the chronic illnesses many of us inflict on ourselves, such as diabetes, obesity and cardiac disease. “Nearly half of the American population is living with at least one chronic condition,” he says, “and that is consuming 75 percent of our healthcare expenses.”

Constantine also points to the hospital practice of cost-shifting, or passing the shortfalls of Medicare reimbursements to private health insurers.

“As much as $1,500 of a typical family policy goes to pay for this cost shifting,” he says.

Constantine says building on the existing employer-based system is still the best way to slow rising costs.

“We need to address changes in the payment system from fee-for-service to a model that pays on the quality of outcomes,” he says. “Hospitals will have to take responsibility for the additional health problems they cause during patient stays there.”

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